BackgroundDespite a fast-growing economy and the largest anti-malnutrition programme, India has the world’s worst level of child malnutrition. Despite India’s 50% increase in GDP since 1991, more than one third of the world’s malnourished children live in India. Among these, half of the children under age 3 years are underweight and a third of wealthiest children are over-nutrient. One of the major causes for malnutrition in India is economic inequality. Therefore, using the data from the fourth round of National Family Health Survey (2015–16), present study aims to examine the socio-economic inequality in childhood malnutrition across 640 districts of India.MethodConcentration curve and generalized concentration index were used to examine the socioeconomic inequalities in malnutrition. However, regression-based decomposition methodology was used to decomposes the causes of inequality in childhood malnutrition.ResultResult shows that about 38% children in India were stunted and 35% were underweight during 2015–16. Prevalence of stunting and underweight children varies considerably across Indian districts (13 to 65% and 7 to 67% respectively). Districts having the higher share of undernourished children is coming from the particular regions like central, east and west part of the country. On an average about 35% of household in a district having the access of safe drinking water and 42% of household in a district exposed to open defecation. The study found the inverse relationship between district’s economic development with childhood stunting and underweight. The concentration of stunted as well as underweight children were found in least developed districts of India. Decomposition approach found that practice of open defecation is positively influenced the inequality in stunting and underweight. Further, inequality in undernutrition is accelerated by the height and education of the mother, and availability of safe drinking water in a district.ConclusionsThe districts that lied out in a spectrum of developmental diversity are required some specific set of information’s that covering socio-economic, demographic and health-related quality of life of people in those backward districts. More generally, policies to avail improved water and sanitation facility to public and female literacy should be continued. It is also important to see that the benefits of both infrastructure and more general economic development are spread more evenly across districts.

ObjectiveTo assess the prevalence of musculoskeletal disorders (MSDs) as well as the impact of the occupation of waste picking on complaints of MSDs among waste pickers. The study attempts to understand the risk factors for MSDs in various areas of the body.DesignA cross-sectional household survey was conducted using a case-control design. The survey instrument for measuring musculoskeletal symptoms was adopted from a standardised Nordic questionnaire. The impact of the occupation of waste picking on MSDs was analysed using the propensity score matching (PSM) method.ParticipantsThe study population consisted of waste pickers (n=200) who had been working for at least a year and a control group (n=213) selected from among or living close to the same communities.ResultsThe 12-month prevalence of MSDs was higher among waste pickers (79%) compared to controls (55%) particularly in the lower back (54–36%), knee (48–35%), upper back (40–21%) and shoulder (32–12%). Similar patterns were observed in the 12-month prevalence of MSDs which prevented normal activity inside and outside the home, particularly for the lower back (36–21%), shoulder (21–7%) and upper back (25–12%) for waste pickers and controls. Analysis of the impact of waste picking on complaints of MSDs suggests that the occupation of waste picking raises the risk of MSDs particularly in the shoulder, lower and upper back. Older age and longer duration of work are significant risk factors for MSDs.ConclusionsThe findings suggest a relatively higher prevalence of MSDs among waste pickers, particularly in the lower and upper back and shoulder, compared to controls. Preventive measures and treatment to minimise the burden of MSDs among waste pickers are strongly recommended.

Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.

BackgroundThe purpose of this study was to test the reliability, validity and factor structure of GHQ-12 questionnaire on male tannery workers of India. We have tested three different factor models of the GHQ-12.MethodsThis paper used primary data obtained from a cross-sectional household study of tannery workers from Jajmau area of the city of Kanpur in northern India, which was conducted during January–June, 2015, as part of a doctoral program. The study covered 286 tannery workers from the study area. An interview schedule containing GHQ-12 was used for tannery workers who had completed at least 1 year at their present occupation preceding the survey. To test reliability, Cronbach’s alpha test was used. The convergent test was used for validity. Confirmatory factor analysis was used to compare three factor structures for the GHQ-12.ResultsA total of 286 samples were analyzed in this study. The mean age of the tannery workers in this study was 38 years (SD = 1.42). We found the alpha coefficient to be 0.93 for the complete sample. The value of alpha represents the acceptable internal consistency for all the groups. Each item of scale showed almost the same internal consistency of 0.93 for the male tannery workers. The correlation between factor 1 (Anxiety and Depression) and factor 2 (Social Dysfunction) was 0.92. The correlation between factor 1 (Anxiety and Depression) and factor 3 (Loss of confidence) was the highest 0.98. Comparative fit index (CFI) estimate best-fitted for model-III that gave the CFI value 0.97. The SRMR indicator gave the lowest value 0.031 for the model-III.ConclusionsThe findings suggest that the Hindi version of GHQ-12 is a reliable and valid tool for measuring psychological distress in male tannery workers of Kanpur city, India. Study found that the model proposed by the Graetz was the best fitted model for the data.

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BackgroundThe occupation of waste-picking characterised as 3Ds – dangerous, drudgery and demanding. In this context, the study aimed to assess occupational morbidities among the waste-pickers and attempts to identify potential individual level risk factors enhancing health risks. Additionally, economic burden of morbidities has been assessed.MethodsThe burden of the morbidities was assessed and compared with a comparison group through a cross-sectional survey. Waste-pickers (n = 200) and a comparison group (n = 103) working for at least a year were randomly selected from the communities living on the edge of the Deonar dumping site. The difference in the prevalence of morbidities was tested using the chi-square test. The effect of waste picking resulting the development of morbidities was assessed using the propensity score matching (PSM) method. A multivariate logistic regression model was employed to identify the individual risk factors. T-test has been employed in order to analyse the difference in health care expenditure between waste pickers and non-waste pickers.ResultsThe prevalence of morbidities was significantly higher among the waste-pickers, particularly for injuries (75%), respiratory illness (28%), eye infection (29%), and stomach problems (32%), compared to the comparison group (17%, 15%, 18%, and 19% respectively). The results of the PSM method highlighted that waste-picking raised the risk of morbidity for injuries (62%) and respiratory illness (13%). Results of logistic regression suggest that low level of hygiene practices [household cleanliness (OR = 3.23, p < 0.00), non-use of soap before meals (OR = 2.65, p < 0.05)] and use of recyclable items as a cooking fuel (OR = 2.12, p < 0.03) enhanced health risks among the waste pickers when adjusted for the age, duration of work, duration of stay in community and substance use. Additionally, the high prevalence of morbidities among waste pickers resulted into higher healthcare expenditure. Findings of the study suggest that not only healthcare expenditure but persistence of illness and work days lost due to injury/illness is significantly higher among waste pickers compared to non-waste pickers.ConclusionsThe study concluded that waste-picking raised the risk of morbidities as also expenditure on healthcare. Results from the study recommend several measures to lessen the morbidities and thereby incurred healthcare expenditure.

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